Definition

Finger amputations are serious injuries that involve the loss of phalanges of one or more fingers.

Pathology

Finger amputations mostly occur in the distal phalanges of the long fingers and may include the bone as well as the soft tissue including the skin, tendons, vessels, nerves and nail bed. Amputations may also affect one or multiple fingers and extend to the hand palm.

Classification

Finger amputations are classified according to the extent of finger loss and the mechanisms leading to an amputation.

Minor finger injuries involve primarily the soft tissue without exposing the bone. These types of injuries normally do not require surgery but a thorough hygiene regime with dressing and disinfectants to prevent infections.

Extensive finger injuries with bone exposure may include damage to the phalanges. The bone is surgically shortened to allow reconstruction with a soft tissue flap to cover the wound.

Traumatic amputations consist in the total severing of the finger at the time of accident, which may occur at various phalange levels. Depending on the conditions of the amputated part and time from the accident, the surgeon may opt for replantation if conditions are suitable. In young children replantation can allow for a relative normal finger growth.

Causes

Finger amputations are a frequent result of crush incidents or cutting injuries when handling sharp utensils and machines. Amputations occur either directly during the injury itself or as a consequent surgical amputation when the damage is so extensive that the finger cannot be preserved. Finger amputations arise from a large number of mechanisms such as:

Crush injuries

Tear

Severing by sharp knives, blades and machineries

Explosions

Risk factors

The main risk factors for finger amputations are:

Maneuvering of industrial and farming tools and machineries (axes, mixers, chain saws)

Crush injuries (car doors, hammers, machine parts, pressure or fall of heavy objects)

Jamming doors

Home power tools

Lawn mowers

Handling of explosive material or devices

Symptoms

The symptoms of a finger amputation are:

Sharp pain

Extensive bleeding

Movement restrictions

Finger and/or hand deformity

Separation of amputated finger extremity

Treatment

Nonoperative treatment

Management of finger amputations varies in relation to the number of fingers amputated, the phalangeal level at which the amputation has occurred and the integrity of the soft tissue remaining. Conservative or minimal surgical treatment is employed in minor finger amputations affecting the soft tissue. These are usually managed immediately in the Emergency Room and include:

Stop bleeding

Disinfection

Additional treatment includes:

Debridement (removal) of crushed soft tissue

Wound suturing

Hand elevation

Application of ice pads

Painkillers

Administration of NSAIDs

Administration of antibiotics

Splint to prevent movement of the fingers

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Surgical treatment

After obtaining the X-rays the surgeon determines the degree of damage to the fingers and hands. The surgical approach takes into consideration the balance between finger amputation and replantation, relative to the functional outcome and cosmetics. In case of fingertip amputation, the surgeon removes the dead tissue, shortens the bone if necessary, and closes the extremity with a tissue flap.

If the amputation is extensive (involving the phalanges and soft tissue), the detached extremity is preserved under sterile and moist condition for a possible replantation. A soft tissue graft taken from other body parts may be required in case of abundant tissue loss. The goal of surgery is to create a suitable anatomy to eventually fit a finger prosthesis if replantation is not possible.

Reattachment of amputated fingers has a high rate of success but only achieves 50% of normal function. Replantation is not recommended if amputation occurs at the fingertip, single finger, finger base, crush injuries or infection, but is advised in children and following multiple amputations including the thumb.

For example, with the loss of the fifth finger, surgery may retain the corresponding fifth metacarpal bone of the hand, which is aesthetically less likable but functionally superior, or remove it to achieve a continuous contour of the palm. In the second case a smaller palm will lose part of the strength and gripping function.

Complications

Complications following a finger amputation differ relative to severity and treatment modalities.

After surgery:

Infection

Poor wound healing

Tissue defect

Loss of function

Loss of sensation

After finger replantation:

Poor circulation

Reduced movement

Loss of sensation

Altered temperature control

Prolonged period of recovery